Psych test 1 Flashcards
MILD ANXIETY
- Occurs in the normal experience of everyday living
- Increases one’s ability to perceive reality
- Has an identifiable cause!
- Characteristics:
- Vague feeling of mild-discomfort
- Restlessness
- Irritability & impatience
- Apprehension.
- Physical Findings: (tension-relieving behaviors)
- Finger/foot tapping
- Fidgeting
- Lip-chewing
MODERATE ANXIETY
-Perceptual field begins to diminish & selective
inattention can occur
-Ability to think clearly is hampered
-Learning & problem-solving CAN still occur
-Benefits from the direction of others
- Characteristics:
- concentration difficulties
- tiredness
- pacing/shakiness
- change in voice pitch/voice tremors
- increased HR & RR
-Somatic Manifestations: headache/backache, urinary
urgency & frequency, insomnia
SEVERE ANXIETY
- Perceptual field is GREATLY reduced
- Learning & problem solving DO NOT occur
- Not able to take direction from others
- Characteristics:
- Confusion
- Feelings of impending doom
- Hyperventilation
- Tachycardia
- Withdrawal
- Loud/rapid speech
- Aimless activity
PANIC-LEVEL ANXIETY
- Markedly disturbed behavior
- Not able to process what is occurring in the environment
- Looses touch w/ reality
- Extreme fright and horror
- Characteristics:
- Severe hyperactivity, flight, or immobility
- Dysfunction of speech
- Dilated pupils
- Severe shakiness
- Severe withdrawal
- Inability to sleep
- Delusions
- Hallucinations
Mild-Moderate Anxiety Interventions
-Use active listening to demonstrate a willingness to
help & therapeutic communication techniques
-Provide a calm presence, recognize their distress
-Evaluate past coping mechanisms (adaptive vs
maladaptive)
-Offer options for problem-solving
-Encourage participation in activities (exercise) to
temporarily relieve anxiety (promotes
endorphin release & improves mental well-being)
Severe-Panic Level Anxiety Interventions
-Provide an environment that meets the physical & safety needs of the client
-Provide a quiet environment w/ minimal
stimulation
-Use meds/restrains but ONLY after less restrictive
interventions have failed
-Encourage walking & exercise
-Set limits w/ firm & short simple statements
-Repetition is necessary, w/a slow low pitched voice
-Direct client to acknowledge the reality
Kubler-Ross’s 5 STAGES OF GRIEF
1) Denial: stage of shock/disbelief. The client has difficulty believing a terminal diagnosis or loss.
2) Anger: directed towards self, others, or objects. Envy & resentment toward individuals not affected by
the loss
3) Bargaining: the client negotiates in an attempt to reverse/postpone the loss, for more time, or a cure
4) Depression: client is overwhelmingly saddened by the inability to change the situation, the sense of loss is intense
5) Acceptance: client accepts what is happening/ brings a feeling of peace & starts to plan for the future
TARDIVE DYSKINESIA
MANIFESTATIONS:
-Late EPS! Requires months-years of med therapy
for TD to develop
-Involuntary movement of tongue & face (lip
smacking & tongue fasciculations)
-Involuntary movements of arms, legs, & trunk
NURSING ACTIONS/TREATMENTS:
-Evaluate the client after 12 months of therapy & then
every 3 months
-If TD appears, dosage should be lowered or
switched to 2nd-Gen antipsychotic agent
-No reliable treatment
-Purposeful muscle movements help control the
involuntary TD
REPRESSION:
-Unconsciously putting unacceptable ideas, thoughts & emotions out of awareness
-Adaptive: person presenting a speech unconsciously forgets about the time when he was laughed at
while on stage
-Maladaptive: Person w/ fear of dentist continuously forgets to go to their dental appointments
REGRESSION:
- Sudden use of childlike/primitive behaviors that DO NOT correlate with the person’s current age
- Adaptive: Young child wets the bed when they learn that their pet died
- Maladaptive: A person in a disagreement w/ coworkers begins throwing things in the office
PROJECTION:
-Attributing one unacceptable thoughts/feeling to another who does not have them
-Maladaptive: A married client is attracted to another person & accuses their partner of having an
extramarital affair
ANGER:
-A normal feeling/ emotional response to frustration
-Can be positive, but must be expressed in a healthy
manner
-Becomes negative when it is denied, suppressed, or
expressed inappropriately (aggressive behavior)
- Findings:
- Clenched fists
- Low-pitched words through clenched teeth
- Yelling/shouting
- Intense or no eye contact
- Defensive
- Passive-aggressive behavior
- Flushed face
- Anxious/tense
- Disturbed thought process
- Suspicious posturing
- Destruction of property
AGGRESSION:
-Expression of anger
-Intention is to threaten, harm, injure, or cause
damage to self-esteem or physical person
- Findings:
- Pacing
- Restlessness
- Threatening verbally or physically
- Loud, argumentative, obscenities
NURSING INTERVENTIONS: Anger/Aggression
-“Talk down” using therapeutic communication
-Encourage the client to express feelings verbally
-Maintain eye contact & sitting/standing in eye
level
-Avoid accusatory/threatening statements
-Decrease environmental stimuli
-Close observation & 1:1 supervision
-Offer as-needed meds
-Set limits for the patient
-Cognitive behavioral therapy
-Milieu therapy
-Psychotherapy
-Seclusion & Restraints:
-LAST RESORT!
-Remove the client from seclusion or restrains as
soon as the crisis is over
-IM meds can be given if aggression is
threatening
NURSE AND CLIENT THERAPEUTIC RELATIONSHIP
- Pre-interaction Phase: consult other sources of information on client, self-check in & obtain information
- Orientation Phase: (introductory) gather data, establish plan together, set limits/boundaries, and goals
- Working Phase: (maintain trust) action plan, evaluate & adapt to ensure progress
-Problem solving model = identifying strategies to ensure success, guiding through interventions, utilizing
therapeutic communication & evaluating/updating as needed
-Termination Phase: patient progresses to next level of care
GROUP DEVELOPMENT PHASES
PHASE 1: Initial/Orientation Phase
- Defines the purpose and goals of the group
- Group leader sets a tone of respect, keeps members
on task
- Members comply, superficial/overly polite members
- Trust has not yet been established
- Members introduce & get to know one another
PHASE 2: Working Phase
- Promotes problem-solving skills to facilitate
behavioral changes
- Group leader uses therapeutic communication to
encourage group work toward meeting goals
- Trust established in members
- Conflict management with minimal assistance from
leader
PHASE 3: Termination Phase
- Sense of loss felt as the grief process prevails
- Leader facilitates re-directing on accomplishments
- Members may feel a sense of abandonment
- Group members discuss termination issues
LEADERSHIP STYLES
AUTOCRATIC:
- Leader completely controls the direction/structure of
group
- Does not allow group interaction/decision-making to
solve problems
- Production: high
- Morale: low
DEMOCRATIC:
- Member-driven, supports group interaction & decision
making (to solve problems)
- Groups offer each client opportunities for growth &
feelings of belonging
- Production: low
- Morale: high
LAISSEZ-FAIRE:
- No direct leader, progresses w/o any attempt by
leader to control the direction
- No identified goals = frustration & chaos
- Productivity: low
- Morale: low
ERIKSON STAGES OF PSYCHOSOCIAL DEVELOPMENT
INFANCY: Birth-18 months
Trust vs Mistrust
-Develops basic trust in mothering figure & is able
to generalize it to others
TODDLERS: 18 months-3 years
Autonomy vs Shame and Doubt
-Gains self-control & independence within
environment
PRESCHOOL: 3-6 years
Initiative vs Guilt
-Develop sense of purpose & ability to initiate/direct
own activities
SCHOOL AGE: 6-12 years
Industry vs Inferiority
-Sense of self-confidence by learning, competing, &
receiving recognition from others
ADOLESCENT: 12-20 years
Identity vs Role Confusion
-Integrates tasks mastered in previous stages into
a secure sense of self
EARLY ADULTHOOD: 20-30 years
Intimacy vs Isolation
-Forms an intense, lasting relationship/commitment
ADULTHOOD: 30-65 years
Generality vs Stagnation
-Achieved life goals established for oneself, also
considering the welfare of other generations
OLD AGE: 65 years-death
Integrity vs Despair
-Review one’s life & derive meaning from both
positive & negative events
MAOI’s & WHAT TO AVOID
- Effect: Reduce depression & control anxiety
- Side Effects:
- Sedation & dizziness
- Sexual dysfunction
- hypertensive crisis (Interaction w/ tyramine)
- Tyramine Containing Foods to AVOID:
- Ripe avocados or figs
- Fermented/smoked meats
- Liver
- Dried/cured fish
- Most cheeses (especially aged)
- Some beer/wine
- Protein dietary supplements
SSRIs (Selective Serotonin Reuptake Inhibitors)
-Effect: leading treatment for depression
- side effects:
- nausea
- increased sweating
- insomnia
- tremors
- sexual dysfunction
Avoid use of St. John’s Wort (can increase risk of serotonin syndrome)
ANTIPSYCHOTICS: 1st Gen: Chlorpromazine
- Therapeutic Uses:
- schizophrenia spectrum disorders
- bipolar disorder (primarily manic phase)
- Tourette disorder
- Agitation
- Prevention of nausea/vomiting
-Extrapyramidal Adverse Effects:
-Acute dystonia: severe spasm of tongue, neck,
face & back. Crisis situation, RAPID treatment
-Pseudoparkinsonism: bradykinesia (slow movement)
rigidity, shuffling gait, drooling, tremors
-Akathisia: inability to sit/stand still, continual
pacing/agitation
-Tardive dyskinesia (TD): Involuntary movements
of tongue & face (lip-smacking & tongue
fasciculations)
-Involuntary movements of arms, legs & trunks
-Neuroendocrine effects: weight gain, menstrual
irregularities, & galactorrhea
-Neuroleptic malignant syndrome: sudden high fever,
BP fluctuations, diaphoresis, tachycardia, muscle
rigidity, decreased LOC, coma
-Orthostatic hypotension: lightheadedness & dizziness
-Sedation: diminish within a few weeks
-Seizures: greatest risk for those who already have
an existing seizure disorder
-Severe dysrhythmias: Obtain baseline ECG &
potassium levels prior to treatment!
-Sexual dysfunction: common in all genders
-Skin effects: photosensitivity & contact dermatitis
-Liver impairment: anorexia, nausea, vomiting,
fatigue, abdominal pain, jaundice
OLANZAPINE: Antipsychotic/mood stabilizer
- Effect: decreased manifestations of psychoses
- Adverse Effects:
- Increased liver enzymes
- Agitation
- Dizziness
- Sedation & sleep disruption
- Orthostatic hypotension
Zolpidem: Sedative/ Hypnotics
- Effects: sedation & induction of sleep
- Adverse Effects:
- agitation/behavior changes
- hallucinations
- prolonged reaction time
- blurred/double vision
- GI upset
- physical & psychological dependence
- unusual sleep behaviors (sleep walking, driving)
LITHIUM LEVELS:
- Normal = 0.4-1.0 mEq/L
- Lithium Toxicity Manifestations:
- severe nausea/vomiting, hand tremors, confusion & vision changes
MENTAL-HEALTH CLIENT RIGHTS:
-Informed consent & right to refuse treatment
-Confidentiality
-Communication with people outside the mental
health facility (family, attorneys, etc)
-Care provided w/ respect, dignity and w/o
discrimination
-Freedom of harm related to physical and
pharmacological restrains & seclusion
SECLUSION & RESTRAINTS:
- Least Restrictive First:
-verbal interventions (encouraging client to calm
down)
-Diversion/redirection
-Providing a calm environment
-Offering a PRN medication - NEVER use seclusion/restraint for:
-Convenience of the staff
-Punishment of the client
-Clients who are extremely physically or mentally
unstable
-Clients who cannot tolerate the decreased stim.
of seclusion room - Provider MUST prescribe restrains & seclusion in
writing - Time limits for seclusion/restraints:
- 18+ years = 4 hrs
- 9-17 years = 2 hr
- 8 years and younger = 1 hr
- Nursing Responsibilities:
- Complete documentation every 15-30 min
- Offer food, fluid, and toileting
- Monitor VS and pain
- Restraint/seclusion MUST be discontinued when the client begins to exhibit normal behavior
